Bilateral pulmonary embolism associated with peripheral blood eosinophilia and positive antiphospholipid antibodies in a patient with cellulitis

Abstract

Key clinical message: This report described the pathophysiology, diagnostic workup, and management of thrombosis possibly associated with peripheral blood eosinophilia and transient positive antiphospholipid antibodies in the setting of cellulitis.

Abstract: Peripheral blood eosinophilia is a risk factor for thrombosis and the presence of other prothrombotic factors such as antiphospholipid antibodies can potentiate that risk. The authors present a case of acute pulmonary embolism which developed at the peak of eosinophilia, later found to have transient positive antiphospholipid antibodies in a male patient with right lower limb cellulitis and a history of intravenous drug abuse. This report illustrates the pathophysiology, diagnosis workup, and therapeutic options of thrombosis possibly associated with peripheral blood eosinophilia and positive antiphospholipid antibodies, which include anticoagulants, corticosteroids, and immunosuppressants. Clinicians should be aware of this possible association which may guide the choice and duration of anticoagulants. Although direct oral anticoagulants are effective anticoagulants in various thromboembolic events, studies showed unfavorable outcomes for their use in antiphospholipid syndrome.

Keywords: anticoagulants; antiphospholipid antibodies; cellulitis; eosinophilia; thrombosis.

FIGURE 1

CT brain (axial view) showing acute hemorrhagic cerebral infarction at the left temporoparietal region with midline shift and mass effect.

FIGURE 2

CTPA showing large intraluminal thrombus in both right and left main pulmonary arteries and nearly complete obstruction of both lower lobes' pulmonary arteries highlighted by a red arrow.